Losartan-induced sprue-like enteropathy: A case report

Chávez-Sánchez S.A.; Espinoza-Ríos J.L.; Pinto-Valdivia J.L.; Guevara-Miranda J.M.; Cáceres-Pizarro J.A. · Revista Colombiana de Gastroenterologia (2026) · DOI: 10.22516/25007440.1532

Resumen

Introduction: Sprue-like enteropathy induced by angiotensin II receptor antagonists (ARBs) is an uncommon entity, initially described with olmesartan and later with other drugs in the same class. It is characterized by chronic diarrhea, weight loss, and histological changes similar to celiac disease, but with negative serology. Case presentation: We present the case of a 75-year-old woman receiving long-term treatment with losartan who developed diarrhea and progressive weight loss. Duodenal biopsies showed villous atrophy and chronic inflammation. After discontinuing the drug, the patient achieved complete clinical resolution. Discussion: The differential diagnosis includes refractory celiac disease, inflammatory bowel disease, and infectious enteropathies. The key finding is the temporal relationship with drug use, the absence of positive serology for celiac disease, and resolution of symptoms after withdrawing the ARB. Conclusion: This case reinforces the importance of considering ARB-induced enteropathy in the differential diagnosis of chronic diarrhea, especially in the presence of negative celiac serology.

Instituciones: Universidad Peruana Cayetano Heredia